NEW ORLEANS – Compared to six years ago, the
number of orthopedic surgeons willing to see a child with a broken arm who is
covered by Medicaid has dropped 39 percent, and even children with private
insurance may face obstacles in getting a timely appointment, according to
research presented Oct. 21 at the American Academy of Pediatrics (AAP) National
Conference and Exhibition in New Orleans.
In the study, “National Access to Pediatric
Fracture Care,” five general orthopedic practices were identified in each
state. Each office was called with a private cellphone using the following
script: “My 10-year-old son broke his arm while out of the country last week.
He was splinted and told to see an orthopedic surgeon within one week. His
fracture does not involve the growth plate.”
Only 23.2 percent (58 out of
250) of the practices across the country agreed to schedule an appointment for
a pediatric fracture patient with Medicaid. Of the offices that declined an
appointment request, 38 percent said that they do not accept Medicaid patients.
The 10 states with the lowest Medicaid reimbursement rates offered an
appointment 6 percent of the time; the 10 states with the highest level of
reimbursement, 44 percent. The same group of 10 lowest Medicaid reimbursement states
offered an appointment to a PPO patient 88 percent of the time, and the 10 best
Medicaid reimbursement states, 82 percent of the time. Eighty-two percent of
the offices nationwide agreed to see a patient with private PPO insurance. Nine
states were identified where all five offices refused the Medicaid patient, but
all five accepted the PPO patient (Connecticut, Illinois, Louisiana, New
Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota and Texas).
Compared to data published in 2006, the number
of offices in 2012 willing to see a child with private insurance has declined
from 92 percent to 82 percent. The number of offices willing to see a child
with a fracture and Medicaid insurance has decreased from 62 percent to 23
percent – a decline of 39 percentage points.
“Underinsured children continue to have
difficulty accessing care for their fractures,” said study author Christopher
Iobst, MD, who cited
low Medicaid reimbursement rates as the most likely reason for practices
refusing to see patients. In addition, “patients with private insurance are
also being turned away at an increasing rate” for a variety of reasons. Forty-six percent of
the offices contacted in the study were unable to refer the family to an
orthopedist who would take care of the child.
“This paradigm shift has resulted in a greater
number of children getting referred to pediatric tertiary care centers
(hospitals) for their care, even for routine injuries,” said Dr. Iobst. While
receiving care at these centers is beneficial, “many patients are forced to
drive long distances to receive care for routine injuries. This places an
unnecessary burden on families that often have limited resources.”
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The American Academy of Pediatrics is an organization of 60,000 primary
care pediatricians, pediatric medical subspecialists and pediatric surgical
specialists dedicated to the health, safety and well-being of infants,
children, adolescents and young adults. For more information, visit www.aap.org.
